Carlos Medicis Morel

Combating Tropical Infectious Diseases: Report of the Disease Control Priorities in Developing Countries Project

Infectious diseases are responsible for >25% of the global disease toll. The new Disease Control Priorities in Developing Countries Project (DCPP) aims to decrease the burden of these diseases by producing science-based analyses from demographic, epidemiologic, disease intervention, and economic evidence for the purpose of defining disease priorities and implementing control measures. The DCPP recently reviewed selected tropical infectious diseases, examined successful control experiences, and defined unsettled patient treatment, prevention, and research issues. Disease elimination programs against American trypanosomiasis (Chagas disease), onchocerciasis, lymphatic filariasis, leprosy, trachoma, and measles are succeeding. Dengue, leishmaniasis, African trypanosomiasis, malaria, diarrheal diseases, helminthic infections, and tuberculosis have reemerged because of inadequate interventions and control strategies and the breakdown of health delivery systems. Application of technologies must be cost-effective and intensified research is essential if these and other scourges are to be controlled or eliminated in the 21st century.

Chagas disease, from discovery to control - and beyond: history, myths and lessons to take home

There is a sad dissociation between the crucial role that research plays in improving health and the general lack of recognition of its role, importance and priority in public health policies. We tend to forget how much we owe to research once a success story in disease control achieves a happy end. Health authorities and policy makers use to say that they want the real thing ‐ in other words, disease control, now ‐ and not lose time and money with unnecessary and odd expenses ‐ in other terms, health research for tomorrow. Therefore, I decided to choose as the subject of my lecture a success story in disease control in South America and to point out to the role research has played along its development. It starts at the very beginning ‐ the discovery of the disease ‐ and goes until the most recent chapter ‐ its elimination as a major public health problem in large regions of the Southern Cone countries. Although no one can yet assure a final “happy end” to this story, progress in its control has been very successful, to the point that the World Health Organization calls it a disease whose days are numbered (Division of Control of Tropical Diseases, 1996). It is a long story ‐ 90 years of history ‐ that illustrates the fundamental importance of research in improving health. By analyzing it, studying the actors, the personalities, the facts, the true or false stories ‐ in other words, the myths ‐, I think we can derive some universal notions and also some lessons to take home, to keep in mind and put into use when time and opportunity comes. It is a real story, about Chagas disease ‐ from its discovery in 1909 by the Brazilian scientist Carlos Chagas working at the Oswaldo Cruz Institute in Rio de Janeiro to its successful control in the large regions of the Southern Cone countries in the 90s. THE INCREDIBLE ‐ AND IMPROBABLE ‐ DISCOVERY